Can architecture and design facilitate healing?
The book is hardly stingy in its diagnosis of hospital architecture, “its complications are widespread, its multi-headed paternity, its muddled, incoherent, inelegant and bipolar forms”. The results are often bad, the facilities designed to care for the sick are confusing, frightening, even worse. Murphy wonders “What made this place so indifferent to the human experience?” Why the indignity? Where’s the design? “
A first glimpse into Health architecture is revealing, mainly composed of shots with occasional axonometry; it becomes clear that the appearance of these buildings is irrelevant in the long run. This design approach always demands attention, due to the practical demands that explain how hospitals have evolved. We are far from the hospital basilicas that begin this list, but the early proximity of the altar reflected a more fundamental organizational relationship, that of patients to nurses, a requirement whose logic is purely internal and has often been achieved with few windows. or any coherent relationship with the exterior of a building.
Growing awareness of the importance of ventilation, with great credit to hospital reform pioneer Florence Nightingale, has made the building envelope more prominent. Isambard Brunel’s prefabricated field hospitals were a first justification for this idea of the Crimean War; death rates at his Renikoi hospital were around three percent; those at a nearby barracks hospital were completed forty percent.
The era of opening windows did not last, however, as machines took over. Reyner Banham appears naturally, the authors noting his early attention to the consequence of Royal Victoria Hospital, Belfast, as the authors observe, “the first to implement forced air ventilation as a means of controlling the environment of the hospital. indoor air and regulate its heat and humidity.
The rise of the hermetically sealed box meant that hospitals could once again turn inward, inflating and rising in ways that natural ventilation would not have allowed. Albert Kahn’s order for Ann Arbor University Hospital (with three kilometers of corridors) is obvious as emblematic of this scaling up, “it was a closed system in which patients moved along. from one service assembly line to another — a healing factory.
The few healthcare facilities that are in the design canon appear more often as outliers than as repeatable pinnacles. The Sanitorium of Paimio in Alvar Aalto in Finland is wonderful but inherently small and unyielding. Others have met the demands of the moment but have gone out of fashion due to trends that are completely beyond their control. Bertrand Goldberg’s Prentice Women’s Hospital, unfortunately deceased, was well designed: “the top illustrates the basic ratio of nurse to patient; below is the systems, operations and technology control center. The trouble was, the mechanical parts weren’t content with that space and kept demanding more and more of it.
The efforts to articulate the mechanical requirements are certainly intriguing: E. Todd Wheeler’s highly visible ventilation at his St. Mary of Nazareth Hospital in Chicago or Louis Kahn’s Richards Laboratories in Chicago. His Salk Institute was a rare and efficient building that stood the test of time, with half floors for more mechanical elements than any need during construction.
Even when future changes were seen as inevitable, it was difficult to say what form this would take. Eberhard Zeidler’s McMaster Health Center in Hamilton, Ont. Was built as a series of repeatable modules, one framework that worked, but most of it didn’t. Mazes often result. Who hasn’t made three lefts and two rights to realize that we are still two stories under the skybridge? The account features occasional heroes but plenty of villains, with Bellevue as a rather atypical avatar of “institutionalization and dehumanization”.
And the world offers ever new challenges. The sealed environment that has become de rigueur suddenly turned out to be flawed by the COVID-19 pandemic. The authors report that New York’s Mount Sinai Hospital is moving patients from newer departments to a 1930s building because there were still windows that could be opened.
MASS Design Group’s particularly thoughtful design of Rwanda’s Butaro District Hospital, designed to provide ventilation, nature views and effective care, is a very welcome coda in the volume and features prominently in Conception and healing. With a broader focus on open source design, the exhibit showcases both newer and innovative buildings and other medical technology, from a range of low-cost one-bed masks for a cholera treatment center to Port-au-Prince to both UK smart thermometers and Bangladesh negative pressure ventilators designed at a fraction of the cost of previous ventilators. Design, like disease, is a problem that can never be fully overcome, but progress is always possible.
Design and Healing: Creative Responses to Epidemics is now on view in the Cooper Hewitt Design Process Galleries through February 20, 2023.